Voter Registration and Information Update Form
Please read instructions carefully. Please type or print clearly with blue or black ink.
For further information, you may consult the Secretary of State’s website at: or call 1-877-767-6446.
Eligibility
Registering by Mail
If you register by mail and do not provide either a current Ohio driver’s
You are qualified to register to vote in Ohio if you meet all the
license number or the last four digits of your Social Security number,
following requirements:
please enclose with your application a copy of one of the following
1. You are a citizen of the United States.
forms of identification that shows your name and current address:
2. You will be at least 18 years old on or before the day of
the general election.
Current valid photo identification card, military identification, or
current (within one year) utility bill, bank statement, paycheck,
3. You will be a resident of Ohio for at least 30 days
government check or government document (except board of
immediately before the election in which you want to vote.
elections notifications) showing your name and current address.
4. You are not incarcerated (in jail or in prison) for a felony
conviction.
Residency Requirements
5. You have not been declared incompetent for voting
Your voting residence is the location that you consider to be a
permanent, not a temporary, residence. Your voting residence is the
purposes by a probate court.
place in which your habitation is fixed and to which, whenever you
6. You have not been permanently disenfranchised for
are absent, you intend to return. If you do not have a fixed place of
violations of election laws.
habitation, but you are a consistent or regular inhabitant of a shelter or
other location to which you intend to return, you may use that shelter
Use this form to register to vote or to update your current Ohio
or other location as your residence for purposes of registering to vote.
registration if you have changed your address or name.
If you have questions about your specific residency circumstances, you
may contact your local board of elections for further information.
NOTICE:
This form must be received or postmarked by the 30th day
before an election at which you intend to vote. You will be notified by
Your Signature
your county board of elections of the location where you vote. If you
In the area below the arrow in Box 14, please write your cursive,
do not receive a notice following timely submission of this form, please
hand-written signature or make your legal mark, taking care that it
contact your county board of elections.
does not touch the surrounding lines so when it is digitally imaged by
your county board of elections it can effectively be used to identify your
Numbers 1 and 2 below are required by law. You must answer both
signature.
of the questions for your registration to be processed.
Please see information on back of this form to learn how to
obtain an absentee ballot.
Registering in Person
If you have a current valid Ohio driver’s license, you must provide that
WHOEVER COMMITS ELECTION FALSIFICATION IS
number on line 10. If you do not have an Ohio driver’s license, you must
provide the last four digits of your Social Security number on line 10. If
GUILTY OF A FELONY OF THE FIFTH DEGREE.
you have neither, please write “None.”
FOLD HERE
I am:
Registering as an Ohio voter
Updating my name
Updating my address
1. Are you a U.S. citizen?
Yes
No
2. Will you be at least 18 years of age on or before the next general election?
Yes
No
If you answered NO to either of the questions, do not complete this form.
3. Last Name
First Name
Middle Name or Initial
Jr., II, etc.
4. House Number and Street (Enter new address if changed)
Apt. or Lot #
5. City or Post Office
6. ZIP Code
7. Additional Rural or Mailing Address (if necessary)
8. County (where you live)
FOR BOARD
USE ONLY
SEC4010 (Rev. 6/12)
9. Birthdate (MO-DAY-YR) (required) 10. Ohio driver’s license No. OR
Ohio Driver’s License No. OR
11. Phone No. (voluntary)
City, Village, Twp.
Last Four Digits of Social Security No.
last 4 digits of Social Security No.
(one form of ID required to be listed or provided)
(one form of ID required to be listed or provided)
Ward
12. PREVIOUS ADDRESS IF UPDATING CURRENT REGISTRATION - Previous House Number and Street
Precinct
Previous City or Post Office
County
State
School Dist.
13. CHANGE OF NAME ONLY Former Legal Name
Former Signature
Cong. Dist.
14.
Date_______/_______/_______
Your Signature
I declare under penalty of
MO
DAY
YR
election falsification I am a
Senate Dist.
citizen of the United States, will
have lived in this state for 30
House Dist.
days immediately preceding
the next election, and will be
at least 18 years of age at the
time of the general election.